Modern Pediatrics. Ukraine

Efficacy and tolerability of basic treatment with montelukast and fluticasone propionate in school-age children with asthma combined with allergic rhinitis

T.R. Umanets — 2025-02-27

Conducting post-marketing studies to study the effectiveness and safety of the use of leukotriene antagonists, in particular montelukast, in alternative treatment regimens for children with comorbid asthma remains important for personalized therapy.

Aim - to study the effectiveness and tolerability of basic therapy with the use of montelukast 5 mg and fluticasone propionate 125 mcg in children with comorbid mild asthma and comorbid moderate asthma, combined with mild persistent allergic rhinitis (AR).

Materials and methods. The clinical effectiveness and tolerability of two basic treatment regimens were prospectively analyzed: montelukast 5 mg monotherapy (group I, n=28, patients with mild asthma and RA) and combined use with fluticasone propionate 125 mcg per day (group II, n=20, patients with moderate asthma and mild persistent AR) for 12 weeks in children aged 6-11 years. The controllability of asthma symptoms was assessed using the validated Children's Asthma Control Test (C-AСT) questionnaire, and the symptoms of asthma were assessed using the visual analog scale (VAS).

Results. Basic therapy with the use of montelukast had a positive effect on the controllability of asthma and AR symptoms in the both groups of children, which was evidenced by a probable (p=0.000) increase in the C-AСT test index with a higher score in children of the II group (p=0.006). Against the background of treatment, the total VAS index in children of the groups I and II decreased by 2.8 times. Monitoring of adverse events against the background of treatment in the studied groups of children testified to the good tolerability of the applied treatment regimens. Only 1 (3.6%) child of the group I had minor abdominal pain.

Conclusions. Monotherapy with montelukast and combined use with fluticasone propionate effectively controls the symptoms of mild and moderate asthma combined with mild persistent RA in children, and is well tolerated.

The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Committee on bioethics and deontology of these institutions. The informed consent of the children's parents was obtained for the research.

No conflict of interests was declared by the authors.

Measles prevalence and vaccination coverage of children in Ukraine (period 2012-2023)

N.V. Banadyha — 2025-02-27

The last decade has become a real test for medicine, associated with mass outbreaks of measles infection, both among children and adults. Under these conditions, Ukraine's position was extremely difficult, since the last measles outbreak (2017-2019) demonstrated high morbidity, as a result of inadequate specific vaccination.

Aim - to investigate the features of measles prevalence and track the activity of a specific vaccination program among children in Ukraine.

Materials and methods. Official reporting documents of the Ministry of Health of Ukraine, the World Health Organization (WHO) on the number of children with measles in the period 2012-2023 were studied. An analysis of the activity of the vaccination campaign in the period 2012-2023 was conducted. from measles, mumps, rubella (MMR).

Results. It is known that measles has a cyclical course, the last outbreak in Ukraine was in 2017-2019. It demonstrated the dependence of the number of patients on the volume of vaccination. In particular, among children aged 1-4 years, one dose was received maximally in 2021 (75%), and the minimum coverage was in 2016 (19.23%) and 2017 (17.09%). 100% coverage with two doses of vaccination was only in 2021, in other periods - the number of vaccinated children is significantly lower than recommended. High incidence of measles was accompanied by a significant proportion of hospitalized patients. The high frequency of hospitalization among schoolchildren is of particular concern. After analyzing the situation with the activity of the vaccination campaign in Ukraine in recent years, a decision was made to conduct a “catch-up vaccination”, which covered 153 thousand children.

Conclusions. Measles infection remains one of the most common and severe, which can significantly reduce the quality of a person’s life in the future. Cyclic outbreaks of measles depend, first of all, on the level of vaccination. In Ukraine, in conditions of war, the low level of measles vaccination coverage of children remains, which exposes them to the danger of another epidemic. The practice of “catch-up vaccination” can improve the protection of children and increase the level of collective immunity.

The authors declare no conflict of interest.

The impact of the COVID-19 pandemic on the physical and mental health of children and adolescents

H.M. Danylenko — 2025-02-27

The aim of this study is to identify the most significant factors that influenced the quality of life of school-aged children with chronic non-communicable diseases during COVID-19.

Materials and methods. There were 2.905 respondents in total: 2.135 children aged 10-18 years who studied in general secondary education institutions (health groups 1-3), 770 children and adolescents who sought help at the clinics (health groups 4-5).

Results. The most significant issue for all children and adolescents in the context of the COVID-19 pandemic was the threat of illness of their relatives. The second most significant issue was that children could not attend school and had to start online learning. The most common place to find information about COVID-19 was on the Internet, less often from parents, and even less often from the media and friends. Most children and adolescents did not notice any changes in their health (84.3%). Of those who experienced changes, 22.5% reported feeling unwell, drowsiness, weakness, disability, fatigue, 21.2% reported physical inactivity, and 26.5% reported deteriorating vision. They also complained of headaches, migraines, weight gain, knee pain, high blood sugar, and other. As a manifestation of the impact on the emotional and psychological state, children reported mood swings, depressive thoughts, aggressiveness, irritability, agitation, and emotional instability (14.2%). Concerns about the COVID-19 pandemic were expressed primarily in anxiety and tension in 27.3% of respondents almost constantly and 24.8% - sometimes (“from time to time”); 25.5% admitted to a sense of uncertainty and instability; 19.4% were threatened with COVID-19.

Conclusions. Children have gained some experience and have prioritized the realization of the value of life and health, not only their own but also their loved ones. The second and third places were shared by mastering online learning, the ability to manage their time wisely, and expanding knowledge of hygiene skills during the pandemic. About 12% of children and adolescents have reconsidered their attitude to communication and having friends, connections with society, and have acquired new hobbies.

No conflict of interests was declared by the authors.

Comprehensive assessment of the health status of early-age children with undifferentiated connective tissue dysplasia signs

O.Yu. Chumak — 2025-02-27

The ontogenetic affinity of connective tissue components with cells of the immune system predetermines the development of infectious, autoimmune, and allergic syndromes in patients with undifferentiated connective tissue dysplasia (UCTD). The relevance of today is to study the peculiarities of the morbidity of infants and early-age children who had locomotor and biochemical signs of UCTD in the neonatal period.

Aim - to investigate the correlation between the markers of UCTD in newborns and clinical manifestations of UCTD, as well as the peculiarities of morbidity in them at the age of 1-36 months.

Materials and methods. At the first research stage, anthropometric and biochemical (matrix metalloproteinase-1 (MMP-1), tissue inhibitor of matrix metalloproteinase-1 (TIMP-1)) markers of UCTD had been studied in 122 newborns. At the second stage, 49 children from among those examined in the neonatal period up to the age of 36 months were subjected to follow-up observation. Phenotypic (external) and visceral (cardiac) signs of UCTD, as well as infectious, allergic, and autoimmune morbidity had been investigated by questionnaire survey and clinical examination. The main group (n=31) included children with neonatal anthropometric markers of UCTD, the control group (n=18) included children without signs of UCTD.

Results. In children with neonatal markers of UCTD at the age of 36 months, a combination of multiple phenotypic and cardiac signs of UCTD was diagnosed. A higher morbidity of iron deficiency anemia (IDA), food allergies, asthma, atopic dermatitis, allergic rhinitis, juvenile idiopathic arthritis (JIA) was determined in children against the background of UCTD. The children of the main research group had more episodes of acute respiratory infections (ARI) and acute intestinal infections (AII) during the year. The presence of UCTD was associated with the morbidity of infectious mononucleosis (IM) and acute RSV-bronchiolitis. It was found that neonatal MMP-1 activity and MMP-1/TIMP-1 index correlated with the morbidity of IDA, JIA, allergic diseases, ARI, AII, IM, RSV-bronchiolitis in children aged 1-36 months.

Conclusions. The children with neonatal markers of UCTD at the age of 36 months have a combination of multiple clinical signs of this disease. UCTD is a prognostically unfavorable factor for infectious morbidity, development of autoimmune and allergiс diseases, and formation of comorbid and associated somatic pathology in early-age children.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of an institution. For each child, the informed consent of its mother to participate in the study was obtained.

The authors declare no conflict of interest.

Vitamin D status and VDR gene polymorphism in children with gastroduodenal pathology

K.B. Nakonechna — 2025-02-27

The relationship between vitamin D deficiency and the development of diseases has been established. It exerts its influence on the body through its connection with vitamin D receptors (VDR). The VDR gene is found in most tissues of our body, including the digestive system.

Aim - to study the association of gastroduodenal diseases with hypovitaminosis D and VDR gene polymorphism in children.

Materials and methods. 104 children with gastroduodenal pathology aged 6-17 years (main group) and 38 practically healthy patients admitted for elective surgical intervention for inguinal hernia (control group) were examined. The level of vitamin D and VDR gene polymorphism were determined in all children. For comparison between groups, Fisher's exact p-value (two-tailed) and Pearson's chi-square test (χ²) were used. The results of the comparison between groups were considered statistically significant at p<0.05.

Results. In children with gastroduodenal pathology, a normal level of vitamin D (≥30 ng/ml) was found in 21 (20.2%) patients, and a reduced level in 83 (79.8%). In patients with normal and reduced levels of vitamin D, the chi-square test for ApaI polymorphism genotypes was χ²=0.295, p>0.05, and for TaqI VDR gene polymorphism it was χ²=5.099, p>0.05, while Fisher's exact test for the presence of the Tt genotype of TaqI polymorphism was p=0.0465. The distribution of actual frequencies of ApaI VDR gene polymorphism genotypes between the main and control groups, due to the difference in the distribution of AA and aa genotypes according to the chi-square test, showed significant differences - χ²=8.317, p=0.016. For TaqI VDR gene polymorphism, the empirical value of the chi-square test was 3.931, p=0.14.

Conclusions. Children with gastroduodenal pathology need vitamin D level correction. The Tt genotype of TaqI VDR gene polymorphism is a likely predictor of vitamin D deficiency in children with gastroduodenal pathology. In children with the AA genotype of ApaI VDR gene polymorphism, an inverse relationship is observed regarding the likelihood of developing gastroduodenal diseases, while with the aa genotype, there is a direct positive association.

The study was conducted in accordance with the principles of the Helsinki Declaration. Informed consent was obtained from the children's parents for conducting the research.

No conflict of interest was declared by the author.

The formation of schoolchildren's health under the influence of medical and psychological factors: challenges of the modern school

Yu.V. Marushko — 2025-02-27

The growing prevalence of chronic non-communicable diseases among children highlights the need to examine the role of psychological and medical factors in shaping schoolchildren’s health.

The study aimed to analyze how psychological personality traits (PPT) and associated behavioral risks contribute to the formation of respiratory (RSD) and digestive system diseases (DSD), and to justify the implementation of preventive medical and psychological interventions.

Materials and methods. A randomized controlled study included 1,110 children aged 9-17 years and used a double-blind design. Health indicators were assessed in relation to established PPTs such as anxiety, aggressiveness, impulsivity, insecurity, externality, asociality and aesthetic insensitivity. Data collection and analysis were performed using the Universal Online system, version 45.

Results. Anxiety significantly increased the risk of DSD (OR=2.16), while its association with RSD was not statistically significant (OR=1.29). Dishonesty was found to be a notable risk factor for RSD. Asociality was a significant predictor for both RSD (OR=1.53, 95% CI: 1.00-2.36) and DSD (OR=1.89, 95% CI: 1.23-2.91). These findings emphasize the importance of early detection of psychological risk factors to prevent systemic dysfunctions and atypical disease courses.

Conclusions. Psychological traits can act as significant medical risk factors, contributing to the development of somatic disorders during the educational process. The integration of psychological screening and support into school health programs may reduce disease incidence, improve children's adaptation, and enhance educational outcomes. Multidisciplinary support from parents, teachers, and health professionals is essential to mitigate the negative impact of harmful traits and promote healthier development.

No conflict of interest was declared by the authors.

Laboratory-instrumental diagnostics and individual rehabilitation program for children with cerebral palsy

O.V. Kyryk — 2025-02-27

Cerebral palsy (CP) is one of the most frequent causes of childhood disability in the world and in Ukraine. CP affects posture, balance, and the ability to move, which leads to varying degrees of impaired activity and functioning in children. Reducing the risk of secondary complications in children with CP is possible with early diagnosis and rehabilitation at an early age. The early intervention service (EI), which provides support and rehabilitation according to an individual program for children with cerebral palsy from birth to 4 years, contributes to improving the functional capabilities of the child.

Aim - to carry out a comparative analysis of disorders in children aged 4 to 14 years with spastic CP, depending on whether they underwent an individual rehabilitation program within the framework of the EI service from birth to 4 years of age.

Materials and methods. The study involved 105 children aged 4-14 years, divided into two groups: the Group A (43 children who received EI) and the Group B (62 children who did not). The level of violations in children was assessed using standardized international scales and laboratory-instrumental methods.

Results. Children in the Group A had less pronounced orthopedic complications (scoliosis, hip dislocations, etc.). Children in the Group A had higher vitamin D levels (24.98±1.164 ng/ml versus 20.85±1.194 ng/ml). Electrocardiogram and complete blood count parameters did not reveal statistically significant differences between the groups.

Conclusions. EI service from birth to 4 years with the use of an individual rehabilitation program has a positive effect on the prevention of secondary complications in children with CP, contributing to the improvement of activities, functioning and participation of children with CP.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Associations between joint status and immunological parameters in children with juvenile idiopathic arthritis

G.Z. Salamzade — 2025-02-27

Laboratory diagnostics of juvenile idiopathic arthritis (JIA) allow us to clarify the diagnosis, determine the subtype of the disease, and assess the inflammatory and immunological activity.

The aim of our study was to assess the associations between joint status and immunological parameters.

Materials and methods. Our study included 80 JIA patients aged 2 to 18 years: 39 (48.8%) boys and 41 (51.2%) girls. The Control group consisted of 20 children: 5 (25.0%) boys and 15 (75.0%) girls. All children underwent physical examination, complete blood count (CBC), biochemical and immunological blood tests, and X-ray examination of the affected joints. Correlation relationships were determined using the ρ-Spearman criterion.

Results. Among all classes of immunoglobulins, the most interesting observations were those regarding IgA. Thus, we obtained a significant positive correlation between IgA and arthritis of several joints: hand joints, elbow joints, shoulder joints, knee joints. A positive correlation was established between an increase in concentration of IgG and lesions of the following joints: hand joints (arthritis), shoulder joints (stiffness, arthritis), temporomandibular joints (tenderness). Also, we obtained a significant positive correlation between IgM and tenderness of elbow joints. Involvement of the joints of the upper limb in the process is more common in polyarticular forms of JIA, with an aggressive course, so, high concentrations of IgA correlate with the severity of the process. IL-6 positively correlated with lesions of the knee joints (stiffness; arthritis) and ankle joints (arthritis)

Conclusions. Thus, the obtained significant positive correlations between immunological parameters and the condition of the joints allow us to assert that immunoglobulins A, M, G, and IL-6 correlate with the severity of the disease and the processes of joint damage.

The research was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Biological marker Lyso-GL1 in Gaucher disease type 1 as a key to successful diagnosis, monitoring of clinical course and treatment of an orphan disease

O.V. Zozulia — 2025-02-27

Gaucher disease type 1 (GD 1) is a hereditary disease caused by a deficiency of the enzyme glucocerebrosidase, which leads to the accumulation of glucocerebroside in cells, especially in macrophages. The disease affects the spleen, liver, bones and bone marrow. One of the key diagnostic markers is glucosylsphingosine (Lyso-GL1), which reflects the accumulation of glucocerebroside and indicates the presence of GD1. Lyso-GL1 is important for early diagnosis, monitoring disease progression and assessing the effectiveness of therapy. A decrease in the level of this biomarker during treatment indicates its success, which allows adjusting drug doses and predicting the patient's response to therapy.

Aim - to determine the importance of studying the Lyso-GL1 biomarker in the diagnosis and monitoring of GD1.

Material and methods. Lyso-GL1 levels were analyzed in 27 children with GD1 aged 11 months to 21 years from 2014 to 2024 to assess the effectiveness of treatment, optimize the results of enzyme replacement therapy with imiglucerase, and improve the individual approach.

Results. Lyso-GL1 levels can be a prognostic indicator of the risk of developing organ damage or complications. Patients with higher Lyso-GL1 levels have a higher risk of developing hematopoietic system failure (anemia, thrombocytopenia), serious damage to both internal organs (enlarged liver and spleen), and bones (presence of bone pain and bone crises), which indicates the prevalence of this marker not only for monitoring therapy, but also for predicting the course of the disease.

Conclusions. Lyso-GL1 level is an important and reliable tool for the diagnosis and treatment of GD1. Its use in clinical practice significantly affects the accuracy of diagnosis, allows for individualization of treatment and promotes long-term monitoring without the need for frequent invasive procedures.

The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Bioethics and Deontology Committee of the institution specified in the work. Informed consent of patients was obtained for the study.

The authors declare that there is no conflict of interest.

Lejeune's syndrome in children: modern ideas

T.V. Pochynok — 2025-02-27

Lejeune syndrome, Cri du Chat syndrome (CdCS), cat cry syndrome, deletion syndrome of the short arm of chromosome 5 (5p), 5p-syndrome was discovered in 1963 by the French geneticist J. Lejeune. The name "cat cry" syndrome refers to the most characteristic clinical sign, a high-pitched cry, similar to the meow of a cat, which usually disappears in the first years of life.

The syndrome occurs as a result of complete or partial absence of the short arm of the 5^th chromosome (from 35% to 55%), which is associated with de novo chromosome deletion in more than 85% of cases. In recent years, the use of genetic molecular methods has made progress in the diagnosis of CdCS.

Aim - to consider various aspects of CdCS (epidemiology, clinical features, diagnostic methods, treatment and prognosis).

A clinical case of Lejeune syndrome in an 8-month-old girl who was being treated in the neurology department of the "Children's Clinical Hospital No. 4, Kyiv. The girl is 8 months old. She was admitted to the neurological department with a delay in physical, stato-kinetic and mental development, hearing loss against the background of Lejeune syndrome, condition after surgery for congenital heart disease "Coarctation of the aorta". A multidisciplinary team of doctors was created. A clinical and laboratory examination was conducted and treatment was prescribed, which included drugs that stimulate the child's psychomotor and physical development. At 12.5 months, the child was holding her head, turning over and sitting on her own. She was enrolled in an early intervention program to improve her quality of life.

Conclusions. Survival rates and life expectancy are high in children with Lejeune syndrome. The type of deletion, its size and location have a significant impact on the clinical features of the syndrome and on the prognosis of the patient's life. The main factor that can improve the prognosis of patients with CdCS is early diagnosis, as it allows establishing early therapeutic and preventive methods aimed at potentiating the physical and mental development.

The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child's parents was obtained for the research.

The authors declare no conflicts of interest.

Polycythemia in childhood: diagnostic challenges

O.I. Dorosh — 2025-02-27

Polycythemia is an increase in hemoglobin/hematocrit levels, indicating several conditions that lead to elevated red blood cell production. It’s crucial to identify true polycythemia vera (PV), which needs targeted treatment to manage blood cell production and prevent complications like thrombosis. Secondary polycythemia (SP) requires identifying and addressing the underlying cause to normalize blood counts. Each type has distinct causes and mechanisms that guide treatment and complication prevention.

Aim - to analyse the clinical features of polycythemia and approaches to its diagnosis in children on the basis of clinical cases.

Clinical cases of children with polycythemia were analyzed alongside a literature review. Diagnostic methods included blood count, cytological and pathological examinations, molecular genetic testing (in two labs), as well as imaging techniques like ultrasound, electrocardiography, echocardiography, radiography, computed tomography, and fibrogastroduodenoscopy, colonoscopy.

Four clinical cases of polycythemia are described: SP in a 14-year-old girl with a congenital heart defect and pulmonary hypertension, showing chronic hypoxia and hypoxemia; іdiopathic рolycythemia (IP) in a 16-year-old boy who smokes; PV in two children with the JAK2 V617F mutation: a 16-year-old girl with coagulogram changes, facial and hand hyperemia, and a 17-year-old boy with splenomegaly. The focus is on the similarities and differences in clinical and laboratory features of these polycythemia types in children, highlighting the need for additional studies, including genetic testing, for accurate diagnosis.

Conclusions. Discrepancies in the clinical and laboratory presentation of different types of polycythemia emphasize the need for an integrated approach to diagnosis for disease’s timely detection, prescription of effective treatment and prevention of complications.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Giant juvenile fibroadenoma of the mammary gland (analytical review of the literature and personal observation)

V.S. Konoplitskyi — 2025-02-27

Fibroadenoma refers to widespread tumors of the mammary gland in childhood, while their nature is very different from pathology in adults. Giant juvenile fibroadenoma of the mammary gland belongs to the benign formations of the mammary gland, the structure of which consists of estrogen-sensitive epithelial and stromal tissues, the frequency of which reaches up to 27.9% in the pre- and 72.1% in the postmenarchal periods.

Aim is to highlight the experience of diagnosing and treating giant juvenile fibroadenoma of the breast on an analytical review of literature and clinical case example.

The article presents a clinical case that demonstrates the clinical course of a giant fibroadenoma of the mammary gland, as well as the method of surgical treatment of this pathology using mastopexy after tumor removal, which leads to a good cosmetic effect in the postoperative period. The diagnostic algorithm for giant juvenile fibroadenoma of the mammary gland consists of determining the visual and palpable changes of the mammary gland and involving certain additional examinations with the help of ultrasound, mammography, MRI and biopsy, which also help in differential diagnosis. Doppler ultrasound in 80% of cases reveals hypervascularization of the mammary gland. Differential diagnosis of giant juvenile fibroadenoma of the mammary gland is carried out with phylloid tumors, pseudoangiomatous stromal hyperplasia, virginal hypertrophy, hamartoma, lipoma, breast abscess, macrocyst, adenocarcinoma. Undisputed indications for surgical treatment of giant juvenile fibroadenoma of the mammary gland are suspicious characteristics during its visualization, including during ultrasound (increase in the density of intra-tissue vascularization) and rapid growth of the tumor formation. The need to remove a giant juvenile fibroadenoma of the mammary gland at a young age is also due to the preservation of the ability to lactate, minimizing injury to the mammary gland, supporting the development of its parenchyma by reducing the hypoxic effect of compression on normal tissue and good cosmetic results, which is also of great importance.

Conclusions. Giant juvenile fibroadenoma of the mammary gland refers to rare tumors in girls during puberty, which are characterized by rapid growth and deformation of the mammary gland. The final diagnosis is possible only through morphological verification. After the diagnosis, a satisfactory oncological and cosmetic result is possible with timely surgical intervention and appropriate rehabilitation.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

No conflict of interests was declared by the authors.

Facial nerve paralysis in Lyme borreliosis in a child (clinical case)

H.B. Mateiko — 2025-02-27

Lyme disease is an infectious disease caused by bacteria of the Borrelia burgdorferi complex. Skin lesions in the acute stage occur in most patients, and nervous system lesions are the second most common in Europe and the third after lesions of large joints.

Aim - to demonstrate the features of the clinical course, diagnosis and treatment of neuroborreliosis using the example of a case of facial palsy in a 13-year-old girl.

Clinical case. The patient was admitted to the hospital with complaints of a feeling of heaviness and numbness of the face, difficulty chewing food, speech disorders, difficulty smiling, incomplete closure of the right eyelid and dryness in it, partial loss of taste, increased irritability, emotional lability. These complaints appeared acutely for 2 days, they were preceded by the pain behind the right ear and the child was consulted by an ENT specialist, who ruled out acute otitis. The epidemiological history was unremarkable. On examination: general condition of moderate severity due to neurological symptoms - the child does not delay the air in the mouth when pressured from the outside, the right corner of the mouth does not move when smiling. The eyebrows are frowned, but on the affected side she can not raise an eyebrow. The nasolabial fold is smoothed on the right side, the corner of the mouth is lowered and the eyelid is lowered on the right side, there is asymmetry of the smile, the inability to completely close the eye. Laboratory tests excluded the herpesvirus etiology of the disease and were obtained positive results for antibodies to Borrelia by enzyme-linked immunosorbent assay (ELISA) - IgG and IgM, which were confirmed by Western Blot. The final diagnosis was made: Lyme borreliosis, early disseminated stage, facial nerve paralysis, moderate severity. Antibiotic therapy was prescribed for 28 days, nonsteroidal anti-inflammatory drugs (NSAIDs), vitamin B complex, artificial tears. The treatment was effective and and contributed to the improvement of the general condition of the child.

Conclusions. The difficulties of diagnosing Borreliosis in this case are due to the denial of the fact of a tick bite, the absence of clinical symptoms in the early stage and a monosymptom in the form of damage to only the facial nerve on the right side.It is important to detect the disease in time to prevent complications (involuntary muscle spasms, their atrophy, contracture of facial muscles, chronic conjunctivitis).

The study was performed according to the principles of the Declaration of Helsinki. Informed consent of the parents was obtained for the research.

The authors declare that there is no conflict of interest.

Fibrinolysis and bleeding of unknown cause

L.Ya. Dubey — 2025-02-27

Patients with Bleeding of Unknown Cause (BUC) have a variety of bleeding symptoms ranging from mild to moderate, but no circulatory disturbances. In clinical practice, hyperfibrinolysis is not sufficiently evaluated as the main cause of bleeding, and there are no commonly known tests for abnormal fibrinolysis.

Aim - to analyse the occurrence of abnormal fibrinolysis and determine the role of specific biomarkers and coagulation tests in its diagnosis, which will improve the understanding and treatment of bleeding in patients with complex coagulation disorders.

Several patients have been reported with distinct fibrinolytic disorders, including α2-antiplasmin deficiency, plasminogen activator inhibitor 1 deficiency, or Quebec platelet disorder. The review aims to summarize data on these established fibrinolytic disorders and discuss the assessment of fibrinolysis in previous cohorts. In addition, we review available global tests with the potential to measure fibrinolysis, such as fibrin clot turbidity assay and rotational thromboelastometry, and their relevance to screening patients with BUC. We concluded that due to the lack of adequate global tests, hyperfibrinolysis may be an underdiagnosed cause of blood coagulation disorders. Diagnosis of hyperfibrinolytic coagulation disorders would improve patient management because effective treatment with antifibrinolytic agents is available.

Conclusions. Detection of hyperfibrinolysis is important in the evaluation of patients with coagulopathy, as it can lead to serious bleeding. The use of antifibrinolytics is an effective treatment. However, complex diagnostic methods, lack of available screening tests and insufficient information about inborn defects in fibrinolytic factors can lead to underestimation of this problem. Future research and newer methods of analysis may improve the diagnosis and treatment of patients with coagulation disorders.

No conflict of interests was declared by the authors.

The role of gene polymorphism in the development of critical conditions of newborns of different etiology (literature review)

E.A. Gasimova — 2025-02-27

In recent years, a key achievement of medical science in diagnostic and prognostic aspects has been the study of molecular-genetic mechanisms involved in developing critical conditions and various diseases in children, especially newborns.

The aim of the study was to evaluate modern concepts about the role of gene polymorphism in the development of critical conditions of newborns of various etiologies, as well as issues of early prediction of these pathological conditions.

This article presents a literature review addressing key issues related to the determination of a significant relationship between gene polymorphism and neonatal pathologies. The study of gene polymorphisms affecting the development of various diseases is currently considered relevant due to the lack of scientific research in this area among the pediatric population. Special attention is given to studies conducted using the Genome-Wide Association Studies (GWAS) method to identify gene loci associated with various pathological conditions occurring in the neonatal period. Understanding the genetic factors influencing fetal development is critical for comprehending diseases’ complexities and severities. Summarizing the theories and hypotheses presented in the article, it can be concluded that studying gene polymorphism and applying an individualized approach to diagnosing neonatal diseases is of great importance.

Conclusions. According to modern concepts presented in the literature, it should be emphasized that the need for early genetic testing of newborns, especially those with risk factors for perinatal asphyxia, can play a decisive role in the timely detection of severe conditions. Various genetic loci and gene mutations contribute to the detailing of clinical manifestations of diseases and risk factors, indicating the importance of identifying gene polymorphisms.

The authors declare no conflict of interest.

The state and prospects of development of medical care for schoolchildren and adolescents in Europe and Ukraine

G.M. Danylenko — 2025-02-27

In the unfavorable conditions of martial law in Ukraine, preserving the health of the younger generation is becoming a crucial task of state policy.

Aim - to determine the optimal model of medical care for school-age children and adolescents of Ukraine based on world and national experience in peacetime, wartime and postwar times. The object of the study is the global and national trends in medical care for schoolchildren in peacetime time and period of a humanitarian crisis: publications of the European Bureau of the WHO, articles in the scientific communication media (2000-2024). The WHO Global School Health Initiative is aimed at improving the educational level of children and promoting healthy lifestyles at the regional, national and global levels. The WHO Office for Europe’s reports determine that investing in the health of children and adolescents brings greater economic and social benefits compared to secondary and other types of disease prevention among the adult population. The concept proposes quality standards for school health services and competencies for school health professionals. According to the results of the project “Child Health Models Appraised” (2018-2020), it was found that there are different models of medical care in educational institutions, differing in terms of subordination, funding, and staff training. The SI "Institute for Children and Adolescents Health Care at the NAMS of Ukraine" (Kharkiv) proposed a program of medical and preventive measures to preserve the health of school-age children and adolescents in the context of a persistent humanitarian crisis.

Conclusions. The most optimal model of medical care for school-age children and adolescents is a multidisciplinary approach to the formation of a healthy lifestyle and the creation of appropriate conditions for its implementation. The solution to the problem of maintaining the health of school-age children and adolescents is of particular relevance in times of humanitarian shocks and needs to be improved in Ukraine today.

The authors declare no conflict of interest.

Features of sexual development in newborns: variants of the norm and deviation

V.M. Dudnyk — 2025-02-27

The identification of the person's biological sex based on various anatomical, physiological, and genetic markers that distinguish men from women, includes genetic, gonadal, and phenotypic sex types.

Aim: to analyze modern data on the definition, diagnosis, and management of patients with disorders of sexual differentiation (DSD) and to present a clinical case of a child at the stage of diagnostic verification.

This categorization process, known as sexual differentiation, is driven by genetic and hormonal factors during prenatal development. Disruptions in this intricate process can lead to DSD, complex conditions characterized by discrepancies between an individual's genetic, gonadal, and phenotypic features. Children with these disorders often face significant challenges in identifying their sex due to atypical and ambiguous external genital features. Such atypical presentations underscore the need for a comprehensive approach to diagnosis and management. Determining the appropriate legal sex of a child affected by these disorders necessitates thorough examinations, including genetic testing. Recent scientific advances have highlighted the pivotal role of histological and karyotypic analyses in classifying and managing DSD, further emphasizing the need for early and accurate diagnosis to facilitate the successful integration of affected individuals into society. An interdisciplinary approach is an integral part of supporting a child with a DSD, where the joint efforts of doctors, psychologists, teachers, and other specialists contribute to creating inclusive and safe conditions for the development of each individual.

No conflict of interests was declared by the authors.